HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y
Date: Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services DEC 2 12015
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 1�� f� l ( Pot fi LUOE� a L.. - `/S�Z
Legal Description: 41z)Vim. PARK J91,K 2.1 W j/d �/ 3V Q��a� 3 53
Property Tax ID#: 9LJl ! -SiD - D.317 -060-`Z Lot No.
Site Plan Name:® Block No.
Project Name:
Setbacks. Front Back: Right Side: Left Side:
FZF NACF ( VAI- s%w'eS ptumA/A7(-'� -7 l ,4-//U!_..
COE-
itional work to be pertormed under trus permit-c ec all that appy:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors.
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction- Sq. Ft.of First Floor:
Cost of Construction:$ !'.0 Utilities: __Sewer _Septic Building Height:
Name It D0/VWY7o -T 4Name:
Address: 14MI— L47A)6 Company:
City: ,.�PPl iZ'l' ST l d C/E State Address:
Zip Code: S' Fax: City: State:
Phone No.,,&" -l. ZipCo Fax:
E-Mail: OR i1 P e No
Fill in fee imple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has_commenced prior to the issuance of a.permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject.structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which;may apply.
In consideration of the granting of this requested permit,I do hereby agree that.I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
-
gnatur •wn r/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA - STATE OF FLORIDA
COUNTY-OF ds°rt OUNTY OF
The forgoing instru ent was acknowled ed before m =a r��:= forgoing g
g g g he for oin instrument was acknowledge before me
this;1 day.of 20�—by q""'.' this day of ,/20_ by
L S a miX 9 roa
(Name of person acknowledging) w c (Name of person acknowledging)
C �T=
c pV m
(Signature of No tate of of Flori a) (Signature of Not Public-State of Florida)
Personally Known OR Produced Identification Personally Kn wn OR Produced Identification..
Type of Identifca ' Type of Ide, ification
Produced C Produced
Commission No. (Seal) Com ission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.